Dissertations / Theses on the topic 'Lower income countries'

This thesis critically analyses the deficits-inflation nexus and inflation targeting in lower-income countries. Previous research has found a significant relationship between fiscal deficits and inflation in low-income countries, but not in high-income countries. It is shown here that the crucial factor is the quality of institutions. The relationship holds in countries with weak institutions, but not in those with strong institutions, even if their per capita GDP is quite low. The implication is that institutional improvements can enhance macroeconomic outcomes in poor countries. The robustness of the findings is tested using various measures of institutional quality. On the other hand, we provide new insights on inflation targeting (IT) in low-income countries. Previous research on inflation targeting has focused on high-income and emerging market economies since low-income countries (LICs) were slow to adopt the framework. Only recently has enough data accumulated for the performance of IT in LICs to be assessed. We show that unlike in emerging markets, in LICs IT is not been effective in reducing inflation. Weak institutions, a typical feature in LICs, do help explain this especially when we examine their role under floating exchange rate regimes. Finally, we characterise monetary policy in Ghana, one of the earliest low-income countries to adopt an IT framework, but where IT has not been very successful in reducing the levels and volatility of inflation within a modified Taylor rule. We investigate whether poor conduct of monetary policy is responsible for the poor performance of IT and find that is not. Monetary policy reaction functions are similar to those estimated for countries with successful monetary policies, and interest rates respond in the theoretically recommended way to inflation shocks.

Despite the impressive progress over the last two decades in which millions of people worldwide have gained first time access to improved water and sanitation infrastructure, the reality for many is that shortly after infrastructure construction the actual service received by users slips back to unacceptably low levels. However, due to inadequate research and inconsistencies with how data and cost data has been collected and reported, very little is known of the necessary levels of expenditure required to sustain an acceptable (so called “basic”) water and sanitation service and this inhibits effective financial planning for households, communities, governments and donors alike. This thesis sought to provide a better understanding of what has historically been spent to provide different levels of water and sanitation services as a means to better understand the necessary expenditure required. Empirical findings are based on a large data sample of nearly 2,000 water points, over 4,000 latrines, and over 12,000 household surveys, which have been collected as part of three research projects (WASHCost, Triple-S, and WASHCost Sierra Leone), across five country research areas (Andhra Pradesh (India), Burkina Faso, Ghana, Mozambique, and Sierra Leone). Findings for water supply systems show that the combination of high capital investments of: $19 and $69 per person for community point sources and $33 – $216 per person for piped systems; and low recurrent expenditures of: $0.06 - $0.37 per person per year for point sources and $0.58 - $7.87 per person per year for piped systems; results in less than half of users receiving a “basic” level of service. Evidence based estimates of the required expenditure for acceptable services are found to be far greater than the “effective demand” expressed in terms of the willingness to pay of service users and national government for these services. Findings for sanitation show that constructing a household latrine that achieves “basic” service standards requires a financial investment of at least $40 that is likely to be an unaffordable barrier for many households in lower income countries. In addition the costs and affordability of periodic pit emptying remains a concern. Ultimately this research suggests that if international standard of improved water and sanitation services are to be sustained in rural areas, the international sector will likely have to provide additional investments to meet a significant proportion of the recurrent costs of delivering these services.

Drinking water is a basic necessity and plays a vital role in improving general health and wellbeing. Following recognition of the essential human right to drinking water, Sustainable Development Goals (SDGs) have included a dedicated Goal 6 (Target 6.1) for drinking water, which addresses a broad range of issues such as availability, accessibility, water quality, and inequalitiesin service. The expanded need for more sophisticated SDG monitoring therefore places high demands on data sources. By combining spatial analysis and modelling techniques with water point data sets, this study proposes several approaches to combine scarce information relating to drinking water services and thereby to facilitate national SDG monitoring. Specifically, spatial integration with water point data was found to be an effective way to add value to conventional data sources such as censuses for monitoring drinking water. In addition, MaxEnt-based predictive modelling method was employed to predict the potential geographical distribution of drinking water supply in the absence of completely surveyed national water point inventories; outputs for Cambodian and Tanzanian examples showed good discriminatory power based on AUCs (0.791 and 0.860 respectively). Although the MaxEnt modelled surface could not replace real water point surveys, it could reasonably give an indication of the potential distribution of water supply and thereby to be used to reveal hidden inequalities in drinking water services, or to investigate surrounding issues by combing with other geospatial data sets.

Rural water supply and sanitation in low and middle income countries face the same challenges now as in the 1970s. Despite massive efforts in providing communal “borehole with handpump” and “improved latrines” to improve the lives of millions of people, this traditional approach to development is failing to deliver long lasting improved services - even if for the last 40 years many attempts have been made to solve problems in the approach. The main research question is “Can low-income rural families pay for rural water supply and sanitation?” This thesis has analysed household poverty and costs on water and sanitation services in Mozambique and Ghana based on 3,049 surveys collected between 2009-2010 by the IRC International Water and Sanitation Centre WASHCost project. Evidence shows that even extreme poor households can and do pay for improved water and sanitation services. However, households prefer to pay for more expensive services to reduce the distance required to collect water instead of paying for the cheaper maintenance of communal (further away) sources. For sanitation, without targeted support towards the poorest, improved latrines might be unaffordable. Also, without follow up support, behaviour change and health impact will not be sustained. Small increases in the wealth of the poorest have a large impact on the services demanded in terms of quantity, distance and time spend as well as an increase in the level of capital and maintenance expenditure. Ultimately, the world now is not the same as in the 1970s and for achieving universal sustainable coverage for water and sanitation we need to rethink the failed traditional approach to development in low income countries with a deeper understanding of the market segmentation in the lowest quintile of the population and their real aspirations and demand.

Air pollution (in terms of PM2.5) is severe in developing countries, and the rapid population growth accompanied by urbanization may limit their potential economic development. This paper aims to investigate if urbanization and economic freedom cause higher levels of PM2.5 in developing countries. By measuring the potential effect of economic freedom on PM2.5 with the Ease of Doing Business-score by the World Bank, a new measure is introduced to the research on socioeconomic factors’ influence on air pollution. It is done by running both fixed effects- and system GMM regressions on a panel consisting of 63 low- and lower-middle-income economies between 2010-2017. The results indicate that PM2.5 is insensitive to changes in both variables and that urbanization’s effect on PM2.5 depends on the level of economic freedom and vice versa. However, both estimators may suffer from bias, and thus, the real relationship of urbanization and economic freedom on PM2.5 remains uncertain.

Background. Within the South African context there is a large body of research regarding the associations between maternal gestational drinking and diagnosable child FASDs. However, there remains a paucity of local research regarding the impacts of other kinds of maternal drinking behaviours (e.g. past and present maternal drinking) and related socio-demographic factors on developmentally sensitive areas of child neurocognitive functioning, such as executive functioning (EF). Methods. This study was cross-sectional in design, utilising a gender balanced sample of N=464 children between the ages of 9.00 and 15.12 (year.months) in three rural areas within the Western Cape. Information regarding maternal drinking behaviours (before, during and after pregnancy) and related socio-demographic factors was collected via structured interviews with mothers or proxy respondents. Six subtests from the Cambridge Automated Neuropsychological Battery (CANTAB), were used to assess three aspects of child EF namely: (1) processing speed, assessed by the MOT and RTI subtests, (2) attention, assessed by the MTT and RVP subtests and (3) memory, assessed by the SWM and PAL subtests. Findings. For all three maternal alcohol use behaviours examined, there was an apparent non-significant trend whereby children of mothers who reported alcohol use (before, during and after pregnancy) performed worse (on average) than children of mothers reporting non-alcohol use on the EF subtests. Several of the socio-demographic factors were found to act as significant predictors of subtest specific EF performance including child sex (RTI: B=.46, p<. 01; MTT: B=.05, p<.05), child age (RTI: B=.27, p<.05; MTT: B=.11, p<.01), home language (MOT: B=- .13, p<.05), maternal employment (MTT: B=-.04, p<.05) and household size (SWM: B=-1.29, p<.05). Conclusions. These study findings provide initial insights into the impacts of different types of maternal drinking behaviours and related socio-demographic factors on child EF outcomes within the context of an LMIC, South Africa.

University of Technology Sydney. Faculty of Health.
[Background] Midwifery educators play a critical role in strengthening the midwifery workforce in low and lower-middle income countries (LMIC) to ensure that women receive quality midwifery care. The most effective approach to building midwifery educator capacity is not always clear. Partnering international and national midwifery educators in education institutions is one strategy to improve the quality of midwifery teaching and learning. [Aim] The aim of this study was to explore how midwifery educator capacity in learning and teaching in LMIC can be strengthened and improved. This research was conducted in two phases. Phase 1 aimed to determine whether one approach – the Papua New Guinea Maternal and Child Health Initiative – contributed to capacity building that was designed to improve midwifery teaching and learning. Phase 2 explored how capacity building using international partnerships is conducted in other LMICs. [Methods] This study used a sequential exploratory mixed method design. During Phase 1, an exploratory qualitative case study design was used. Data were collected from 26 semi-structured interviews conducted with both national and international midwifery educators. A thematic analysis was undertaken. In Phase 2, a descriptive quantitative design was used with data collected from a survey of 18 international and nine national midwifery educators working in 13 different LMICs. Descriptive statistics and content analysis were undertaken. [Findings] In Phase 1, seven themes were identified. The first three provided insights into enabling factors: knowing your own capabilities, being able to build relationships and being motivated to improve the health status of women. The next four themes explored constraining factors: having a mutual understanding of the capacity building project, preparing stakeholders for working together, knowing how to adapt to a different culture, and needing an environment which supports improved midwifery education. Phase 2 confirmed that midwifery educators working in other LMICs experience similar enabling and constraining factors. An individual’s knowledge, skills and attitude influenced the quality of the international partnership. Social norms, institutional support and context also shaped the capacity of midwifery educators to improve teaching and learning. [Discussion and Implications] Individual, partnership and environmental factors influenced midwifery educators to improve teaching and learning in LMIC. Monitoring and evaluation of individual performance, using national and international guidelines may help to provide feedback and build educator confidence. Specific individual preparation for the capacity building partnership would help to ensure that all stakeholders have a mutual understanding, are culturally competent and maintain relevance to the context. Strengthening institutional leadership and infrastructure to provide a supportive working environment would also enable educators to access contemporary teaching resources and research evidence. Supporting the government and community to identify and value the role of the midwife and the development of a well-functioning midwifery regulatory body in LMIC are other enabling factors that need to be addressed. Further research is needed to assess if addressing the individual, partnership and environmental factors identified in this study results in improved midwifery teaching in LMIC.

碩士
國立成功大學
經濟學系
106
Based on lower-middle-income and the higher-middle-income countries’ experiences over the period from 2000 to 2015, this paper analyzes the relationship between government external debt and economic growth by using the methods of system-GMM and the Panel Smooth Transition Regression Model (PTSR). The system-GMM estimation results indicate that the threshold values of the ratio of the government external debt to GDP in the lower-middle-income countries are 34.27% and 77.02%, while those in the higher-middle-income countries are 31.17% and 75.43%. When the ratio is less than the first threshold value or greater than the second threshold value, increases in government external debt result in negative impact on economic growth. When the ratio lies between the first and second threshold values, increases in government external debt result in positive impact on economic growth. The PSTR estimation results indicate that raising government external debt has negative impact on economic growth for both lower-middle-income and higher-middle-income countries. The ratio of government consumption to GDP negatively affects economic growth; the ratio of openness as well as military expenditure to GDP positively affect economic growth in the lower-middle-income countries. The ratio of government consumption to GDP and enrollment rate of secondary schools negatively affect economic growth; the ratios of tax income to GDP as well as national health expenditure to GDP positively affect economic growth in the higher-middle-income countries.

University of Technology Sydney. Faculty of Health.
Background: The global neonatal mortality rate (NMR) is still high, estimated at 19 deaths per 1,000 live births in 2015, which accounts for 45 percent of under-five deaths. Neonatal deaths are projected to increase to 52 percent of under-five deaths in 2030, with most deaths occurring in low and lower-middle income countries (LMICs). This research aimed to examine the key factors that affect the neonatal mortality in LMICs, with a focus on Bangladesh. Methods: This study comprised a systematic review and statistical analyses. The systematic review, using a narrative synthesis methodology, first examined the impact of workforce interventions on neonatal outcomes in LMICs. Statistical analyses of the 2011 Bangladesh Demographic and Health Survey (DHS) data (n=17,842) investigated the key components of health care services, including facility-based delivery, skilled birth attendants (SBAs), essential newborn care (ENC), antenatal care (ANC) and postnatal care (PNC). In addition, statistical analyses of DHS data from Nepal (n=12,674) and Pakistan (n=13,558) were undertaken to compare the impact of facility-based delivery and/or SBAs in reducing NMR in those countries. A separate statistical analysis of the 2014 Bangladesh DHS data (n=17,863) investigated the changes over time in newborn health care practices, from 2011 to 2014. Statistical analyses used in this research included chi-square tests, multiple logistic regression models and Cox proportional hazards regression models. Results: The systematic review found that competency assessment, the acquisition of appropriate skills and supervisory guidelines can improve health professional performance. An empirical investigation of Bangladesh DHS data revealed an improvement in health care practices over time for all socio-demographic groups in the country. A detailed investigation suggested that neonatal mortality significantly decreased for newborns whose mothers received ANC services (HR=0.52; 95% CI: 0.29, 0.96). The ENC practice of delayed bathing significantly contributed to reducing neonatal mortality in Bangladesh (OR=0.14; 95% CI: 0.03, 0.68). However, other ENC practices including PNC and skilled assistance during delivery were not found to be significantly associated with neonate deaths. Furthermore, neonatal mortality was significantly higher for facility deliveries compared to home deliveries in Bangladesh (OR=2.43; 95% CI: 1.09, 5.41). Nepal and Pakistan DHS data also failed to confirm any significant effect of facility delivery and/or SBAs on neonatal mortality. Conclusions: This is the first study to examine the impact of different components of health care practices on neonatal mortality in Bangladesh at a national level and provides important recommendations for saving newborn lives. First, guidelines related to the fabric used for the immediate drying and wrapping of newborns are required to improve hygiene at a baby’s birth. Second, increased emphasis on parental education is required to improve the uptake of ENC services. Third, investment in promoting ANC is important to accelerate the reduction of neonatal deaths. Fourth, revisiting current health intervention programs related to PNC in Bangladesh are essential to better understand the impact of PNC on neonatal mortality. Finally, standardized workforce training and staff supervision are required to improve the performance of health providers. Nevertheless, more research is required to better understand neonatal mortality in LMICs, particularly the reasons why the risk of neonatal deaths increases for deliveries at health facilities and why some ENC practices do not have any impact on neonatal mortality.

Contexto Condições tratadas por cirurgia contribuem com 28-32% de DALY's, excedendo o burden de doenças como VIH/SIDA e tuberculose. No entanto, a concepção errada sobre a custo-efetividade dos cuidados cirúrgicos leva a um escasso investimento na promoção do seu acesso em países de baixo e baixo médio rendimento. Até então, não existem listas oficiais pela Organização Mundial de Saúde para cirurgias essenciais. Metodologia Realizamos uma revisão de literatura sistemática de listas essenciais de cirurgia com aplicabilidade em países de baixo e baixo médio rendimento. De seguida, comparamos e categorizamos as listas recolhidas. Resultados Foi compilado um total de 100 procedimentos, organizados por onze domínios médicos. Os procedimentos mais mencionados eram referentes a cirurgia geral, trauma, seguidos de ginecologia e obstetrícia. Conclusão Existem, na literatura, listas construídas por especialistas. Há uma necessidade para uma lista essencial que possa guiar no fornecimento de cuidados cirúrgicos. Tal lista deve ter input de países membros para garantir que é adequada às necessidades locais. Vários desafios têm sido reportados relacionados com a coleção de dados e com as barreiras no acesso à cirurgia que influenciam de forma significativa o conceito de cuidados cirúrgicos essenciais. Este conceito deverá assentar bases para orientações que levem ao fornecimento adequado de cuidados cirúrgicos a nível nacional e local, integrando coleção de dados e compreensão das barreiras no acesso.
Background Surgically treatable conditions contribute with 28-32% of DALY's, exceeding the burden of diseases such as HIV/AIDS and tuberculosis. However, the misconception over the cost-effectiveness of necessary surgeries leads to low investment in improving access to surgical care in Low and Lower Middle-Income Countries (LIC & LMIC). So far, there is no World Health Organization (WHO) official list of essential surgeries. Methodology We conducted systematic literature research of the lists of essential surgery applicable to LICs & LMICs. We compared the lists gathered and categorized the procedures listed. Results A total of 100 procedures were gathered, spread over eleven medical domains. The most mentioned procedures were general surgery and trauma-related, followed by obstetrics and gynaecology. Conclusions There are, however, existing lists created by different panels of experts. There is a need for an essential surgery list that will guide the provision of surgical care. Such lists should have direr input from member countries to ensure that they are appropriately adapted to the local needs of the country. Various challenges have been reported regarding data collection and barriers in access to surgery that greatly influence the concept of essential surgical care. The concept of essential surgery should lay the foundation for roadmaps leading to the adequate delivery of surgery at a national and local level, integrating data collection and the understanding of the barriers to access.

Contexto Condições tratadas por cirurgia contribuem com 28-32% de DALY's, excedendo o burden de doenças como VIH/SIDA e tuberculose. No entanto, a concepção errada sobre a custo-efetividade dos cuidados cirúrgicos leva a um escasso investimento na promoção do seu acesso em países de baixo e baixo médio rendimento. Até então, não existem listas oficiais pela Organização Mundial de Saúde para cirurgias essenciais. Metodologia Realizamos uma revisão de literatura sistemática de listas essenciais de cirurgia com aplicabilidade em países de baixo e baixo médio rendimento. De seguida, comparamos e categorizamos as listas recolhidas. Resultados Foi compilado um total de 100 procedimentos, organizados por onze domínios médicos. Os procedimentos mais mencionados eram referentes a cirurgia geral, trauma, seguidos de ginecologia e obstetrícia. Conclusão Existem, na literatura, listas construídas por especialistas. Há uma necessidade para uma lista essencial que possa guiar no fornecimento de cuidados cirúrgicos. Tal lista deve ter input de países membros para garantir que é adequada às necessidades locais. Vários desafios têm sido reportados relacionados com a coleção de dados e com as barreiras no acesso à cirurgia que influenciam de forma significativa o conceito de cuidados cirúrgicos essenciais. Este conceito deverá assentar bases para orientações que levem ao fornecimento adequado de cuidados cirúrgicos a nível nacional e local, integrando coleção de dados e compreensão das barreiras no acesso.
Background Surgically treatable conditions contribute with 28-32% of DALY's, exceeding the burden of diseases such as HIV/AIDS and tuberculosis. However, the misconception over the cost-effectiveness of necessary surgeries leads to low investment in improving access to surgical care in Low and Lower Middle-Income Countries (LIC & LMIC). So far, there is no World Health Organization (WHO) official list of essential surgeries. Methodology We conducted systematic literature research of the lists of essential surgery applicable to LICs & LMICs. We compared the lists gathered and categorized the procedures listed. Results A total of 100 procedures were gathered, spread over eleven medical domains. The most mentioned procedures were general surgery and trauma-related, followed by obstetrics and gynaecology. Conclusions There are, however, existing lists created by different panels of experts. There is a need for an essential surgery list that will guide the provision of surgical care. Such lists should have direr input from member countries to ensure that they are appropriately adapted to the local needs of the country. Various challenges have been reported regarding data collection and barriers in access to surgery that greatly influence the concept of essential surgical care. The concept of essential surgery should lay the foundation for roadmaps leading to the adequate delivery of surgery at a national and local level, integrating data collection and the understanding of the barriers to access.

Research Doctorate - Doctor of Philosophy (PhD)
Background: Around 112 million unintended pregnancies occur each year in low- and middle income countries, representing around 39% of the total pregnancies and 92% of total unintended pregnancies (250 million) that occur worldwide. In Bangladesh, around 48% of total pregnancies are unintended at conception, and a significant percentage of these occur among women with previous experience of unintended pregnancy. Around 51% of these end with induced abortion (which is mostly unsafe), and the remaining 49% end with live births, which contributes around 26% of the total live births in Bangladesh. Pregnancy complications,birth injury, and maternal and neonatal mortality are higher among women experiencing unintended pregnancies and are even higher among women with previous experience of unintended pregnancy. Increased attention to the impact of unintended pregnancy is therefore needed to improve maternal and child health, which are vital targets in the Sustainable Development Goals to be achieved by 2030. Maternal healthcare services use, including antenatal healthcare, delivery healthcare, and postnatal healthcare, could reduce the occurrence of unintended pregnancy and its associated complications and deaths. Post-partum contraception use could prevent the occurrence of repeated unintended pregnancy. However, disagreement about the association of unintended pregnancy with maternal healthcare services and post-partum contraception use is common in low- and middle-income countries, and there is sparse research on this topic for Bangladesh. Objectives: The broad aim of this thesis was to investigate the association between unintended pregnancy and maternal healthcare services use. The specific aims were: i) appraise current evidence of the association between unintended pregnancy and antenatal, delivery, and postnatal healthcare services use in low- and lower-middle-income countries; ii) determine the association between unintended pregnancy and antenatal, delivery, and postnatal healthcare services use, as well as the continuity of using these services in Bangladesh; and iii) determine the association between unintended pregnancy and post-partum contraception use in Bangladesh. Design: This thesis comprises a systematic review and cross-sectional analyses of the nationally-representative 2014 Bangladesh Demographic and Health Survey. Participants: Participants in all cross-sectional studies were 4,493 women who reported a live birth within three years prior to the date of the survey and responded to the questions related to maternal healthcare services use. Methods: The multiple objectives of this thesis were addressed through a range of methodological approaches, reported across six papers. In the first paper, a systematic review and meta-analysis were used to collect and appraise existing evidence of the association between unintended pregnancy and antenatal, delivery, and postnatal healthcare services use in low- and lower-middle-income countries. Multilevel modelling was used in the remaining five papers to determine the association of unintended pregnancy with antenatal, delivery, and postnatal healthcare services use, continuity of using antenatal, delivery, postnatal healthcare services, and post-partum contraception uptake. Results: The systematic review identified 38 studies in low- and lower-middle-income countries related to unintended pregnancy and antenatal, delivery, and postnatal healthcare services use. Their pooled odds showed 25-39% lower use of antenatal, delivery, and postnatal healthcare services following an unwanted pregnancy compared to a wanted pregnancy. Follow-up quantitative papers provided insight into this association for Bangladesh, with this study reporting that around 26% of total pregnancies (of which 15% were mistimed and 11% were unwanted) that ended with a live birth were unintended at conception. At least one antenatal healthcare consultation was reported among 64% of Bangladeshi women, 34% of whom reported at least four antenatal healthcare consultations. Only 41% of women reported having a skilled birth attendant present at their last birth, and 38% reported delivery in a healthcare facility. Around one quarter (27%) of women reported postnatal healthcare service use. Only 12% of all women reported using antenatal, delivery, and postnatal healthcare services. Unintended pregnancy was found to be associated with a decreased likelihood of using each of these services. A 27% (95% Credible Interval, 0.66-0.81) and 31% (95% Credible Interval, 0.64-0.75) lower likelihood of at least four antenatal healthcare consultations were found among women who had a mistimed or unwanted pregnancy, respectively, compared to a wanted pregnancy. This association was stronger for unwanted pregnancy than wanted pregnancy for the presence of a skilled birth attendant during delivery (OR, 0.70, 95% Confidence Interval [95% CI], 0.52-0.93), delivering in a healthcare facility with skilled providers (OR, 0.65, 95% CI, 0.48-0.89), and postnatal healthcare services use (OR, 0.58, 95% CI: 0.34-0.98). Further, the odds of using at least two of the recommended antenatal, delivery,and postnatal healthcare services, as well as using all of these services, were 39% (95% CI, 0.47-0.78) and 62% (95% CI, 0.23-0.64) lower for an unwanted pregnancy than a wanted pregnancy, respectively. Mistimed pregnancy (rather than a wanted pregnancy) was not associated with either delivery healthcare services use or postnatal healthcare services use, although mistimed pregnancy was found to be negatively associated with continuity of using recommended antenatal, delivery, and postnatal healthcare services (OR, 0.69, 95% CI, 0.47-0.78). In addition, relative to a wanted pregnancy, 62% (95% CI, 1.28-2.05) higher odds of modern contraception use was found among women with a mistimed pregnancy, whereas no association was found between unwanted pregnancy and post-partum uptake of modern contraception. Conclusion: This study confirms that more than one-quarter of women who reported unintended pregnancy at conception in Bangladesh (and who did not terminate their pregnancies) are at high risk of not using maternal healthcare services. This indicates that the current provision of health coverage does not necessarily translate into actual uptake, challenging Bangladesh's ability to achieve its Sustainable Development Goals targets for reducing preventable maternal and under-five mortality. Earlier detection of women's pregnancy intention and initiatives to include women in the mainstream of maternal healthcare services are important to ensure maternal healthcare services are available to and accessible by women having an unintended pregnancy in Bangladesh.

In the literature, some studies argue that affluence and the financial sector encourages low-carbon investments which result in lower emissions while others find that they enhance emissions. Contemporary studies barely consider agriculture, employment generation and the degree of financial development as determinants of emissions. In view of these, the thesis investigates the impact of economic and financial development on CO2 emissions in sub-Saharan Africa (SSA). Applying the EKC and STIRPAT framework, the study modelled three functional forms which were estimated using an unbalanced panel data of 45 SSA countries by employing static and dynamic analytical methods. The models were re-estimated for 24 low (LIC), 13 lower-middle (LMIC), six upper-middle (UMIC) and two high-income countries (HIC). The study found evidence that empirical results differ in terms of the (sub-) sample of countries, estimation methods and functional forms. In detail, the study found different CO2 emissions-economic development relationships for the income groups. However, there is evidence of a linkage between later developments of the economies with lower emissions in LIC and UMIC while this linkage does not exist in LMIC and HIC. The study also found that financial development lowers CO2 in UMIC while it enhances emissions in LIC, LMIC and HIC. Despite this, there is evidence of a linkage between later developments of financial sectors with higher emissions in LIC and HIC and a linkage between later developments of financial sectors with lower CO2 in UMIC in SSA meanwhile no linkage was found for LMIC. The study concludes that not all economic development increases the level of CO2 emissions and not all financial development limits CO2 emissions in SSA during the study period. Generally, the main contributory variables to CO2 emissions are income, trade openness, energy consumption, population density and domestic credit to private sector to GDP. The main reducing factors of CO2 emissions are agriculture and official exchange rate. The thesis recommends that SSA needs to be more responsive to a cleaner CO2 environment by moving away from the conduct of unclean development strategy to intensified green investments.
Economics
D. Phil. (Economics)